European Child & Adolescent Psychiatry最新文献

Post-traumatic stress disorder (PTSD) in preschoolers is increasingly recognized, yet population-based studies remain scarce, especially in contexts of high urban violence and social vulnerability. We conducted the Brazilian Preschool Mental Health Study in Embu das Artes, a high-risk urban area, enrolling 1,292 children from public preschools and their caregivers. Standardized face-to-face interviews assessed PTSD symptoms (YCPS for children, PCL-C for parents), socioemotional development (ASQ: SE-2), and sociodemographic variables. Associations were examined using logistic regression models. The prevalence of PTSD symptomatology was 3.8% in children and 3.1% in caregivers. Preschoolers' PTSD symptomatology was strongly associated with parental PTSD symptomatology (aOR = 12.20; 95% CI: 8.50-17.52), impaired socioemotional development (aOR = 2.30; 95% CI: 1.62-3.26), and higher socioeconomic status (aOR = 1.84; 95% CI: 1.35-2.51). Affiliation with Protestant religion showed a protective effect (aOR = 0.75; 95% CI: 0.60-0.94). PTSD symptomatology is a significant mental health concern in preschoolers exposed to chronic violence. Its strong association with parental PTSD symptomatology supports intergenerational trauma hypotheses. Findings underscore the urgent need for early identification and intervention strategies targeting both preschoolers and caregiver mental health in vulnerable settings.

Long waitlists are the most commonly reported barrier to accessing mental health services in the UK and across Europe. Yet, we have almost no understanding of the lived experiences of waiting among youth and their caregivers. In this qualitative study, we conducted semi-structured interviews with a purposive sample of 20 youth (aged 11-17) and 15 caregivers from ten child and adolescent mental health services (CAMHS) sites geographically spread across England. We used reflexive thematic analysis to analyse the data. We generated four themes that characterised participants' experiences of waiting: (1) decline in mental and physical health, (2) strain on family dynamics and wider relationships, (3) unclear processes and communication, and (4) perceived mismatch between need and support. We also generated four themes illustrating participants' coping strategies while waiting: (1) using self-help and parenting resources, (2) engaging in hobbies, (3) relying on social support, and (4) seeking alternative services. There is an urgent need to shorten CAMHS wait times as our findings show the adverse impact of waiting on youth and their families, with mental health worsening not just due to time passing but as a direct result of being put on a waitlist. While youth on CAMHS waitlists make active efforts to manage their symptoms, limitations to these coping strategies suggest that improved information sharing and tailored interim support is needed to mitigate against mental health deterioration while waiting.

The relationship between leptin levels and psychiatric disorders has been studied more extensively in adults than in children and adolescents. However, the results are conflicting. We investigated serum leptin levels in children and adolescents (11 to 18.9 years) with psychiatric disorders (n = 363). Absolute and relative (body-mass-index (BMI)-, sex- and pubertal-stage-adjusted z-scores using reference values of healthy children and adolescents) leptin levels of different patient groups according to diagnosis were compared. The association between leptin levels and depression (Beck Depression Inventory-II) and anxiety (Child Behavior Checklist and Youth Self Report) was examined using regression analysis. Leptin z-scores were higher in patients with psychiatric disorders than in healthy controls (median 1.50, p < .001). While global tests suggested differences in leptin z-scores between patients with different psychiatric disorders, these differences could not be attributed to diagnosis groups in post-hoc pairwise comparisons. Absolute leptin levels differed between psychiatric disorders (p < .001). Patients with anorexia nervosa (AN) had the lowest levels, and patients with mood disorders had higher leptin levels than patients with mental disorders other than mood disorders, anxiety or AN. Neither absolute nor relative leptin levels were related to depressive or anxiety symptoms in regression models adjusted for sex and BMI. Significantly elevated BMI-, sex- and puberty-stage-adjusted leptin levels were observed in children and adolescents with psychiatric disorders compared to a reference sample. Further controlled studies are needed to confirm and explain this finding. No relationship was found between absolute or relative leptin levels and symptoms of depression or anxiety.

Pregnant and postpartum adolescents are at high risk of anxiety disorders, yet there is little guidance for the best practices to manage perinatal anxiety in this group. This scoping review examined the literature on pharmacological and non-pharmacological interventions for perinatal anxiety and related disorders in adolescents and youth. We searched MEDLINE, CINAHL, EMBASE, PsycINFO, and SCOPUS from database inception to December 2023 for studies on prevention and treatment (pharmacological or non-pharmacological) of anxiety and related disorders (including anxiety disorders, obsessive-compulsive disorders, and trauma-related disorders) in adolescents (≤19 years; adolescents either examined separately or as part of a young perinatal individual group) between conception and one year postpartum. Ten studies met the inclusion criteria. Sample sizes ranged from 15 to 291 perinatal adolescents/youth. All studies examined non-pharmacological interventions including psychoeducational (n=5), psychotherapeutic (n=4), and complementary and alternative medicine (n=1) interventions. One study focused on treatment, two studies focused on prevention and treatment, and in seven studies, it was unclear whether the focus was prevention, treatment, or both. Psychoeducational interventions involving skill-building, developing knowledge about infants, and how to be a supportive partner showed the most promise in reducing anxiety symptoms. The single art-based psychotherapeutic intervention showed benefit for reducing PTSD symptoms. Limited evidence on managing perinatal anxiety and related disorders in adolescents and youth suggests some promise for educational and art-based therapy interventions. More research is needed to confirm these findings in larger samples and understand how to best implement such interventions to improve outcomes for perinatal adolescents and youth with anxiety and related disorders.

Cluster A personality disorders are hypothesized to have their origins in childhood, but little prospective research exists to support this contention. We investigated whether factors intrinsic to the child, social-relational and environmental factors, and symptoms of other psychopathologies in childhood predict paranoid, schizoid, and schizotypal personality disorder traits at age 16. A sample from two birth cohorts in Trondheim, Norway (n = 1,077; 50.9% female) was examined biennially from age 4-16. Cluster A personality disorder traits were assessed with the Structured Clinical Interview for DSM-5 Personality Disorders and regressed on the intercept and growth in child risk and protective factors up to age 14. The prevalence of any Cluster A PD at age 16 was 2.41% (95% CI: 1.12, 3.69); paranoid 1.36% (CI: 0.42, 2.31); schizoid 0.56% (CI: -0.11, 1.23); schizotypal 1.05% (CI: 0.23, 1.87). Elevated and rising levels of odd or eccentric behavior, heightened and increasing neuroticism, low conscientiousness, declining self-esteem, and growing emotional and behavioral difficulties predicted both paranoid and schizotypal features, whereas low and rising levels of insecure attachment predicted paranoid traits only. Schizotypal traits also shared early risk factors with schizoid traits: Problems with emotion regulation and cluster A traits in parents. Several assumed predictors were unpredictive: Having an imaginary friend, disorganized attachment, negative life-events, and autism spectrum symptoms. In conclusion, cluster A traits at age 16 can be predicted by a range of factors already evident in childhood and early adolescence, most notably oddity, symptoms of emotional and behavioral disorders, low self-esteem, social withdrawal, and personality traits.

Cognitive reserve (CR), referring to the brain's adaptability to maintain functioning despite pathology, has been found to positively impact the clinical manifestations in schizophrenia and bipolar disorder. Here, we aimed to explore the protective role of CR in children at familial high risk of schizophrenia (FHR-SZ) or bipolar disorder (FHR-BP) compared with population-based controls (PBC). This study is part of The Danish High Risk and Resilience Study, a cohort study of 522 seven-year-old children at FHR-SZ (n = 202, 45.6% females) or FHR-BP (n = 120, 46.1% females) and PBC (n = 200, 46.2% females). CR was assessed using principal component analysis including information about child IQ, school performance, peer relations, physical leisure activities, developmental milestones, parental education and occupation, and family leisure activities. Clinical outcomes included child global functioning, lifetime psychopathology, and psychotic experiences. Neurocognitive outcomes included processing speed, sustained attention, verbal memory, visuospatial memory, verbal working memory, and set-shifting. Compared with PBC, CR was lower in children at FHR-SZ (p < 0.001, d = 0.73) and FHR-BP (p < 0.001, d = 0.51). Additionally, children at FHR-SZ had lower CR than FHR-BP (p = 0.042, d = 0.24). Across groups, CR was non-differentially and positively associated with global functioning (p < 0.001) and all neurocognitive outcomes (p ≤ 0.005) and negatively associated with psychopathology (p ≤ 0.007) and delusional psychotic experiences (p = 0.019). Children at high risk have lower CR already at an early developmental stage. CR may serve as a protective factor against the development of psychopathology and neurocognitive impairments, offering a potential target in preventative interventions aiming at altering the long-term trajectories for high-risk populations.

Self-esteem is important for mental well-being. Children of parents with schizophrenia or bipolar disorder have multiple risk factors for low self-esteem. We aimed to examine their development of self-esteem and associations with bullying victimization, caregiver functioning, at-home support, and prevalence of mental illness. In a cohort of 519 children at familial high-risk of schizophrenia (FHR-SZ) or bipolar disorder (FHR-BP) and population-based controls (PBC), self-esteem was assessed with the "I Think I Am" questionnaire at ages 7, 9, 11, and 14. Bullying victimization (using KIDSCREEN-52), caregiver functioning (using Personal and Social Performance Scale), and at-home support (using MC-HOME) were assessed at age 7, and prevalence of lifetime mental disorder (using K-SADS-PL) was assessed at ages 7 and 11. A time x group interaction was found for self-esteem development overall and for the subscales "Psychological well-being" and "Relationships with others" (p ≤ 0.01). Across assessments, lower self-esteem was found among children at FHR-SZ (p ≤ 0.001 for all), but only at age 11 for children at FHR-BP (p = 0.002), compared with PBC. Bullying victimization and low at-home support at age 7 were associated with lower self-esteem (Partial Eta Squared 0.05 and 0.01) at age 14. Low self-esteem at age 7 was associated with mental disorder (Partial Eta Squared 0.19) at age 11. More bullying victimization and poorer home environment quality are associated with later lower self-esteem, and low self-esteem is associated with later psychopathology among children at FHR. Awareness of self-esteem and risk factors for low self-esteem among children at FHR is needed.

The 2025 ESCAP Research Academy Workshop in Strasbourg focused on the impact of psychological trauma on the brain, emphasising mechanistic insights and early intervention strategies. Prior to the ESCAP Congress, this event aims at supporting the next generation of clinician-scientists in child and adolescent mental health (CAMH). Under the guidance of coordinators Alexis Revet and Paul Klauser, nineteen fellows from 13 countries engaged in comprehensive discussions. Keynote speakers Andrea Danese, Isabelle Mansuy, Vera Clemens, and Eric Bui, offered critical insights into trauma mechanisms and interventions. Using the "world café" model, participants developed a European-wide trauma questionnaire, illustrating international collaboration. The workshop, which was supported by the ESCAP Academic division, successfully integrated academic and clinical insights with personal development. The next workshop is scheduled to take place in 2027 in Athens.

This study aimed to determine whether a history of childhood abuse (CA) and baseline serum brain-derived neurotrophic factor (sBDNF) levels predict remission at 12 weeks and 12 months in patients with depressive disorders, and to examine potential interactions between these factors. A total of 1,086 patients with depressive disorders, participating in a naturalistic, stepwise antidepressant treatment study, were assessed at baseline. CA was evaluated using the Nemesis Childhood Trauma Interview, and sBDNF levels were measured. Remission was defined as a Hamilton Depression Rating Scale score of ≤ 7. Logistic regression analyses examined the independent and interactive effects of CA and sBDNF on remission outcomes, adjusting for relevant covariates. Low baseline sBDNF independently predicted poorer remission at 12 months (p = 0.045) but not at 12 weeks (p = 0.720). In adjusted analyses, CA alone did not significantly predict remission at either time point (all p > 0.05). However, patients who had both a CA history and low baseline sBDNF showed significantly lower remission rates at 12 weeks (p = 0.018) and 12 months (p = 0.009), indicating a significant interaction between these factors. These findings underscore the importance of integrating psychosocial and biological factors in personalized depression treatment. Routine screening for childhood trauma, combined with assessment of sBDNF levels, may help identify high-risk patients needing targeted interventions. Further prospective research is necessary to validate these findings.